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Evaluation of the Indirect Hemagglutination Test as an Epidemiologic Technique for Malaria^*

The indirect hemagglutination test is being evaluated as a seroepidemiologic technique for malaria. Employing serology as an epidemiologic method will be especially useful 1) to measure the level of malaria endemicity; 2) to determine whether malaria transmission has been interrupted or reduced; 3) to delineate malarious areas; 4) to detect seasonal changes of malaria transmission; 5) for an independent determination of the intensity and distribution of malaria since it is not necessary to depend on the recorded malariometric surveillance information; 6) for identification of population groups with especially high rates of malaria infection; 7) to assess the coverage of the standard surveillance methods which are used to measure the occurrence of malaria; 8) to determine the role of migrants in the introduction of malaria from malaria endemic areas to receptive areas with little or no malaria; 9) for evaluating sera of malaria infected blood donors; and 10) for surveillance in areas of low endemicity.

The IHA test is well suited for epidemiologic purposes. Large numbers of specimens can be titrated readily at small expense, and blood can be collected by finger prick on filter papers. The specificity of the test with sera from 2,400 individuals was 99.6% and the overall sensitivity with 1,202 specimens was 89%. The antigen prepared from Plasmodium knowlesi is genus specific and will react equally well with all the Plasmodium species causing human malaria. Antibodies are detectable 8 to 27 days after the onset of parasitemia and they can persist for many years after a single infection. With serologic methods, relatively small population samples can be used to measure epidemiologic parameters.

^* This study was supported in part by the U. S. State Department, Agency for International Development, Participating Agency Service Agreement (PASA) No. RA (HA) 5-68.